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DGI:Nosokomiale Pneumonie/Klinisches Bild/Prognose - Revision history
2026-06-11T02:26:36Z
Revision history for this page on the wiki
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https://wiki.cakele.iodatalabs.dev/index.php?title=DGI:Nosokomiale_Pneumonie/Klinisches_Bild/Prognose&diff=6569&oldid=prev
imported>Brinkery at 19:27, 27 November 2025
2025-11-27T19:27:29Z
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<td colspan="2" style="background-color: #fff; color: #202122; text-align: center;">Revision as of 19:27, 27 November 2025</td>
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<tr><td class="diff-marker" data-marker="−"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;">===== <span class="mw-headline" id="Prognostische_Marker">Prognostische Marker</span> =====</del></div></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">Die </ins>der <ins style="font-weight: bold; text-decoration: none;">HAP </ins>und <ins style="font-weight: bold; text-decoration: none;">VAP zuschreibbare Sterblichkeit („attributable mortality“) liegt geschätzt bei ca</ins>. <ins style="font-weight: bold; text-decoration: none;">10 %</ins>, ist <ins style="font-weight: bold; text-decoration: none;">aber wegen </ins>der <ins style="font-weight: bold; text-decoration: none;">i. d. R</ins>. <ins style="font-weight: bold; text-decoration: none;">ausgeprägten Komorbiditäten </ins>und <ins style="font-weight: bold; text-decoration: none;">Zeitabhängigkeit </ins>des <ins style="font-weight: bold; text-decoration: none;">Risikos kaum valide bestimmbar</ins>.</div></td></tr>
<tr><td class="diff-marker" data-marker="−"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;">Zwei Drittel </del>der <del style="font-weight: bold; text-decoration: none;">tödlich verlaufenden nosokomialen Infektionen sind Pneumonien. Lactat </del>und <del style="font-weight: bold; text-decoration: none;"><span class="mw-lingo-term" data-lingo-term-id="c1b9a5bfdcf1b4b586c4953afeff622b" data-hasqtip="64">PCT</span> sind zwei wertvolle Parameter für die Abschätzung der Progression der Erkrankung</del>. <del style="font-weight: bold; text-decoration: none;">Tritt im Rahmen der <span class="mw-lingo-term" data-lingo-term-id="d8efe42bb29f789f68a2272010d551ea" data-hasqtip="65">HAP</span> ein septischer Schock auf</del>, ist der <del style="font-weight: bold; text-decoration: none;">initiale Laktatwert mit der Prognose assoziiert</del>. <del style="font-weight: bold; text-decoration: none;">Serielle Laktatmessung soll darum bei Patient:innen mit akuter Organdysfunktion aus prognostischen Gründen zur Diagnose einer Sepsis </del>und <del style="font-weight: bold; text-decoration: none;">zur Steuerung </del>des <del style="font-weight: bold; text-decoration: none;">Volumenmanagements vorgenommen werden</del>.</div></td><td colspan="2" class="diff-side-added"></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br></td></tr>
<tr><td class="diff-marker" data-marker="−"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;">Eine prognostische Wertigkeit </del>des <del style="font-weight: bold; text-decoration: none;">Verlaufes insbesondere </del>des <del style="font-weight: bold; text-decoration: none;"><span class="mw</del>-<del style="font-weight: bold; text-decoration: none;">lingo</del>-<del style="font-weight: bold; text-decoration: none;">term" data</del>-<del style="font-weight: bold; text-decoration: none;">lingo</del>-<del style="font-weight: bold; text-decoration: none;">term</del>-<del style="font-weight: bold; text-decoration: none;">id="c1b9a5bfdcf1b4b586c4953afeff622b" data-hasqtip="66">PCT<</del>/<del style="font-weight: bold; text-decoration: none;">span> wurde in mehreren Studien bestätigt</del>.</div></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">'''Negative Prognosefaktoren'''</ins></div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">* Initiale Bakteriämie</ins></div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">* Schwere des Lungenschadens</ins></div></td></tr>
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<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">* Hoher SOFA-Score</ins></div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">* VAP durch Aspergillus (Letalität > 50 %) </ins></div></td></tr>
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<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">'''Günstige Prognosefaktoren'''</ins></div></td></tr>
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<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">* Besserung von SOFA, Laktat, CRP/PCT und Oxygenierung</ins></div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">'''Einflussfaktoren'''</ins></div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">Leitliniengerechte Initialtherapie und Fokussierung der Antibiotikatherapie im Verlauf scheinen positiven Einfluss auf die Prognose zu haben.</ins></div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">Bei septischem Schock im Rahmen einer HAP/VAP sollten aus prognostischen Gründen serielle Laktatmessungen zur Steuerung </ins>des <ins style="font-weight: bold; text-decoration: none;">Managements vorgenommen werden. Auch andere Maßnahmen </ins>des <ins style="font-weight: bold; text-decoration: none;">Sepsis</ins>-<ins style="font-weight: bold; text-decoration: none;">Managements erscheinen prognostisch wichtig. (Siehe Sepsis Kapitel) </ins></div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">Es liegt Evidenz vor, dass die Prognose durch eine konsequente Deeskalation der antibiotischen Therapie nicht verschlechtert wird. </ins></div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">Eine antimikrobielle Kombinationstherapie der VAP oder der HAP bringt im Vergleich zu einer Monotherapie mit geeigneten und empfohlenen Präparaten keinen zusätzlichen prognostischen Nutzen.</ins></div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">Als Ausnahme ist hier der Einsatz einer empirischen Kombinationstherapie als Initialtherapie bei Patient:in:innen mit septischem Schock plus MRE</ins>-<ins style="font-weight: bold; text-decoration: none;">Risiko zu nennen.</ins></div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">===== Risikofaktoren für nosokomiale Pneumonien (HAP und VAP) =====</ins></div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">* Höheres Lebensalter (Alter > 65 Jahre)</ins></div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">* Vorbehandlung mit Antibiotika</ins></div></td></tr>
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<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">* Intubation und maschineller Beatmung</ins></div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">* Organversagen und septischer Schock</ins></div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">* Vorerkrankung des Respirationstraktes, inkl des Larynx/ Hypopharynx</ins></div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">* Thorakale oder abdominelle operative Eingriffe</ins></div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">* Schweres Trauma</ins></div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">* Nikotin</ins>-<ins style="font-weight: bold; text-decoration: none;">, Alkohol</ins>- <ins style="font-weight: bold; text-decoration: none;">und Drogenabusus</ins></div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">* Erkrankungen des oberen GI</ins>-<ins style="font-weight: bold; text-decoration: none;">Traktes</ins></div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">* Neurologische Erkrankungen, die mit Dysphagie u.</ins>/<ins style="font-weight: bold; text-decoration: none;">o</ins>. <ins style="font-weight: bold; text-decoration: none;">Verlust der Schutzreflexe einhergehen</ins></div></td></tr>
</table>
imported>Brinkery
https://wiki.cakele.iodatalabs.dev/index.php?title=DGI:Nosokomiale_Pneumonie/Klinisches_Bild/Prognose&diff=6568&oldid=prev
imported>Fuhrmanns: Die Seite wurde neu angelegt: „===== <span class="mw-headline" id="Prognostische_Marker">Prognostische Marker</span> ===== Zwei Drittel der tödlich verlaufenden nosokomialen Infektionen sin…“
2021-08-19T08:12:27Z
<p>Die Seite wurde neu angelegt: „===== <span class="mw-headline" id="Prognostische_Marker">Prognostische Marker</span> ===== Zwei Drittel der tödlich verlaufenden nosokomialen Infektionen sin…“</p>
<p><b>New page</b></p><div>===== <span class="mw-headline" id="Prognostische_Marker">Prognostische Marker</span> =====<br />
Zwei Drittel der tödlich verlaufenden nosokomialen Infektionen sind Pneumonien. Lactat und <span class="mw-lingo-term" data-lingo-term-id="c1b9a5bfdcf1b4b586c4953afeff622b" data-hasqtip="64">PCT</span> sind zwei wertvolle Parameter für die Abschätzung der Progression der Erkrankung. Tritt im Rahmen der <span class="mw-lingo-term" data-lingo-term-id="d8efe42bb29f789f68a2272010d551ea" data-hasqtip="65">HAP</span> ein septischer Schock auf, ist der initiale Laktatwert mit der Prognose assoziiert. Serielle Laktatmessung soll darum bei Patient:innen mit akuter Organdysfunktion aus prognostischen Gründen zur Diagnose einer Sepsis und zur Steuerung des Volumenmanagements vorgenommen werden.<br />
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Eine prognostische Wertigkeit des Verlaufes insbesondere des <span class="mw-lingo-term" data-lingo-term-id="c1b9a5bfdcf1b4b586c4953afeff622b" data-hasqtip="66">PCT</span> wurde in mehreren Studien bestätigt.</div>
imported>Fuhrmanns